Discharged on Supplemental Oxygen From an Emergency Department in Patients With Bronchiolitis

BACKGROUND AND OBJECTIVE: Bronchiolitis is the most common reason for hospital admission in patients aged <1 year. Admissions have been increasing with hypoxia frequently cited as the determinant. Home oxygen (O₂) has been shown to be feasible, although safety data are lacking. The objective of this study was to evaluate the impact of a home O₂ clinical care protocol on admission rates in patients with bronchiolitis from the pediatric emergency department.

METHODS: We performed a retrospective chart review of patients with bronchiolitis who presented to a children’s hospital pediatric emergency department (altitude 1600 m) between 2005 and 2009. Patients between the ages of 1 and 18 months were included in the analysis. Patients requiring baseline O₂ were excluded. We calculated the percentage of patients discharged on O₂ and their readmission rates. We reviewed charts of patients who were admitted after home O₂ for adverse outcomes. We also compared rates of admission before and after initiation of the protocol.

RESULTS: In this study, 4194 illnesses were analyzed; 2383 (57%) were discharged on room air, 649 (15%) were discharged on O₂, and 1162 (28%) were admitted. Of those discharged on room air, 4% were subsequently admitted, and 6% of those discharged on O₂ were admitted. There were no ICU admissions or need for advanced airway management in those patients discharged on O₂. Our overall admission rates for bronchiolitis dropped from a rate of 40% to 31%.

CONCLUSIONS: Home O₂ is an effective way to decrease hospital admissions in a select group of patients with bronchiolitis.